Week in Washington 08122021

Week in Washington is brought to you by Michael Cohen, PhD. Tune in each week to read the latest on healthcare policy and get a glimpse of what’s on the horizon.

Week in Washington



Infrastructure Bill- The bipartisan/physical infrastructure bill passed the Senate this week. The bill spends money on roads, broadband, energy items, etc. To help reduce the deficit implications, the Senate included pay-fors (savers) which came via health care items. In particular, the bill includes:

  • Three-year delay on the Part D rebate rule (now slated for 2026)

  • Extension of 2% Sequestration (the 2% sequestration goes until 2031 now)

  • Reduces Medicare spending on discarded medication from large, single-use drug vials (saves $3 billion)

The bill goes to the House, which has not passed it yet. If the House were to make any changes, then the bill would have to go to a conference committee which would then make changes of its own and have the House/Senate vote on it again (i.e., this could take a while).

The timing/passage is more uncertain than normal as many House Democrats (including Speaker Pelosi) want to make sure a different bill (the reconciliation bill) is passed at the same time (i.e., support for one bill is contingent on passing the other). Consequently, the chances of passing are less than usual, and it may take a while for things to be clear.

Reconciliation Bill

Also passed this week were a series of guiding principles/goals for the reconciliation bill. This bill, as currently envisioned, includes ACA tax credit enhancements, additional Medicare benefits (vision, dental, hearing), and coverage for individuals in the Medicaid coverage gap.  A few updates on the policy status of two of the key provisions:

  • Medicaid: The leading contender for how to get coverage for those in the Medicaid coverage gap is via tax credits to purchase coverage through the ACA Exchanges.

  • Medicare: The Biden White House issued a statement in favor of including a provision that would allow Medicare to negotiate the price of certain drugs.


Unfortunately, COVID cases, hospitalizations, and deaths have markedly increased across the country, as seen below, via Jonah Fleish.

USA Covid Data



The FDA appears poised to approved COVID vaccine booster shots for immunocompromised patients that received Moderna and Pfizer shots in the coming days.

Additional News of Notes

Enrollment Data – CMS announced that more than 2.5 million Americans gained Health Coverage on-Exchange during the SEP this year. The Healthcare.gov SEP ends on August 15th.

Medicare Advantage – Several Medicare Advantage Insurers (most recently Clover Health) released statements that their medical loss ratios (MLR) in the second quarter were high as people received deferred care.

Previous editions: 

8/06/2021: Week in Washington

7/15/2021: Week in Washington

7/08/2021: Week in Washington

7/02/2021: Week in Washington



6/23/2021: Week in Washington

6/17/2021: Week in Washington

6/10/2021: Week in Washington

6/04/2021: Week in Washington


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